Trajectory of Posttraumatic Stress Disorder Caused by Myocardial Infarction: A Two-Year Follow-up Study

Abstract

Objective:A substantial proportion of patients develop posttraumatic stress disorder (PTSD) following myocardial infarction (MI). Previous research on the trajectory over time of PTSD in post-MI patients is scant and refers to self-rated posttraumatic symptoms. The aim of this study was to investigate the longitudinal course of an interviewer-rated diagnosis of PTSD and PTSD symptom severity following MI.Methods:Study participants were 40 patients (78% men, mean age 54 α 8 years) who were diagnosed with PTSD using the Clinician-administered PTSD Scale (CAPS) after an average of 5 α 4 months (range 2–16 months) following an index MI. After a mean follow-up of 26 α 6 months (range 12–36 months), 24 patients underwent a second diagnostic interview.Results:Two-thirds of patients ( n = 16) still qualified for a diagnosis of PTSD at follow-up. In all 24 patients, total PTSD symptoms ( p = 0.001), re-experiencing symptoms ( p < 0.001), avoidance symptoms ( p = 0.015), and, with borderline significance, hyperarousal symptoms ( p < 0.06) had all decreased over time. However, in the subgroup of the 16 patients who had retained PTSD diagnostic status at follow-up, symptoms of avoidance ( p = 0.23) and of hyperarousal ( p = 0.48) showed no longitudinal decline. Longer duration of follow-up was associated with a greater decrease in avoidance symptoms ( p = 0.029) and, with borderline significance, in re-experiencing symptoms ( p < 0.07) across all patients.Conclusion:Although PTSD symptomatology waned over time and in relation to longer follow-up, two-thirds of patients still qualified for a diagnosis of PTSD 2 years after the initial diagnosis. In post-MI patients, clinical PTSD is a considerably persistent condition.